参附注射液辅助治疗静脉注射丙种球蛋白不敏感川崎病患儿的疗效
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摘要
目的探讨参附注射液辅助治疗静脉注射丙种球蛋白(IVIG)不敏感川崎病患儿的临床疗效。方法将68例IVIG不敏感川崎病患儿分为观察组和对照组各34例。两组均给予大剂量IVIG、阿司匹林、双嘧达莫和糖皮质激素等治疗,观察组同时给予参附注射液治疗。观察两组患儿体征消失所需时间、体温正常所需时间、住院天数、治疗总有效率。治疗前和治疗2周后检测患儿血红蛋白、血清白蛋白、纤维蛋白原(FIB)、白细胞介素6(IL-6)、超敏C反应蛋白(hs-CRP)和血管内皮生长因子(VEGF)水平。治疗3个月后,采用超声心动图检测冠状动脉内径及冠状动脉瘤发生情况,评估冠状动脉损伤严重程度。观察治疗期间药物不良反应发生情况。结果与对照组比较,观察组体温正常所需时间、体征消失所需时间、住院天数均更短,总有效率更高(均P<0.05)。治疗2周后,两组血红蛋白、血清白蛋白及FIB均升高,IL-6、hs-CRP和VEGF均降低(均P<0.05),且观察组血红蛋白、血清白蛋白及FIB高于对照组,IL-6、hs-CRP和VEGF低于对照组(均P<0.05)。治疗3个月后,观察组的冠状动脉损伤率、冠状动脉内径、冠状动脉瘤发生率和冠状动脉损伤评分均低于对照组(均P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论在大剂量IVIG、阿司匹林和皮质激素基础上加用参附注射液治疗IVIG不敏感川崎病患儿,能更快地控制临床症状体征,更好地改善血清学指标及炎症指标,并降低冠状动脉损伤率。
Objective To investigate the clinical efficacy of adjunctive therapy with Shenfu Injection for intravenous immunoglobulin(IVIG)-resistant Kawasaki disease in children. Methods Sixty-eight children with IVIG-resistant Kawasaki disease were divided into observation group and control group,with 34 cases in each group. Both groups were treated with high-dose IVIG,aspirin,dipyridamole and corticosteroids,and the observation group also administered Shenfu Injection. Duration for signs disappeared,duration for normothermia,hospital stay,and total therapeutic effective rate were observed in both groups. Before and after 2 weeks of treatment,levels of Hb,serum albumin,fibrinogen(FIB),interleukin 6(IL-6),high-sensitivity C-reactive protein(hs-CRP) and vascular endothelial growth factor(VEGF) were detected in the children. After 3 months of treatment,echocardiogram was used to determine coronary diameter and incidence of coronary aneurysm,then severity of coronary injury was assessed. Incidence of drug adverse reactions was observed during treatment. Results Compared with the control group,the observation group had shorter durations for signs disappeared and normothermia,shorter hospital stay,and a higher total effective rate(all P<0.05).After 2 weeks of treatment,Hb,serum albumin and FIB increased but IL-6,hs-CRP and VEGF decreased in both groups(all P<0.05),moreover,the observation group exhibited increased Hb,serum albumin and FIB,as well as decreased IL-6,hs-CRP and VEGF than the control group(all P<0.05). Three months after treatment,the rate of coronary injury,coronary diameter,incidence rate of coronary aneurysm,and score for coronary injury in the observation group were lower than those in the control group(all P<0.05). No statistically significant difference was found in incidence rate of adverse reactions between the two groups(P>0.05). Conclusion For children with IVIG-resistant Kawasaki disease,additional administration of Shenfu Injection on the basis of high-dose IVIG,aspirin and corticosteroids can control clinical symptoms and sighs more quickly,better improve serological and inflammation indicators,and reduce coronary injury rate.
Objective To investigate the clinical efficacy of adjunctive therapy with Shenfu Injection for intravenous immunoglobulin(IVIG)-resistant Kawasaki disease in children. Methods Sixty-eight children with IVIG-resistant Kawasaki disease were divided into observation group and control group,with 34 cases in each group. Both groups were treated with high-dose IVIG,aspirin,dipyridamole and corticosteroids,and the observation group also administered Shenfu Injection. Duration for signs disappeared,duration for normothermia,hospital stay,and total therapeutic effective rate were observed in both groups. Before and after 2 weeks of treatment,levels of Hb,serum albumin,fibrinogen(FIB),interleukin 6(IL-6),high-sensitivity C-reactive protein(hs-CRP) and vascular endothelial growth factor(VEGF) were detected in the children. After 3 months of treatment,echocardiogram was used to determine coronary diameter and incidence of coronary aneurysm,then severity of coronary injury was assessed. Incidence of drug adverse reactions was observed during treatment. Results Compared with the control group,the observation group had shorter durations for signs disappeared and normothermia,shorter hospital stay,and a higher total effective rate(all P<0.05).After 2 weeks of treatment,Hb,serum albumin and FIB increased but IL-6,hs-CRP and VEGF decreased in both groups(all P<0.05),moreover,the observation group exhibited increased Hb,serum albumin and FIB,as well as decreased IL-6,hs-CRP and VEGF than the control group(all P<0.05). Three months after treatment,the rate of coronary injury,coronary diameter,incidence rate of coronary aneurysm,and score for coronary injury in the observation group were lower than those in the control group(all P<0.05). No statistically significant difference was found in incidence rate of adverse reactions between the two groups(P>0.05). Conclusion For children with IVIG-resistant Kawasaki disease,additional administration of Shenfu Injection on the basis of high-dose IVIG,aspirin and corticosteroids can control clinical symptoms and sighs more quickly,better improve serological and inflammation indicators,and reduce coronary injury rate.
引文
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[3]张清友,简佩君,杜军保.风湿热、心内膜炎及川崎病委员会,美国心脏病学会及美国儿科学会川崎病的诊断、治疗及长期随访指南介绍[J].实用儿科临床杂志,2012,27(13):1 049-1 056.
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[6]程立平.丙种球蛋白联合阿司匹林片治疗川崎病的疗效研究[J].中国临床药理学杂志,2017,33(15):1 425-1 427.
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[11]任琳琳,王彩霞,李静,等.中药联合丙种球蛋白和阿司匹林治疗川崎病疗效观察[J].现代中西医结合杂志,2016,25(17):1 890-1 892.
[12]李开,鄢素琪.中医营气卫血辩证联合丙种球蛋白治疗儿童川崎病的临床研究[J].中华中医药学刊,2016,34(10):2 527-2 531.
[13]夏川江.参附注射液联合人免疫球蛋白治疗川崎病的临床研究[J].现代药物与临床,2016,31(6):834-837.
[14]闫启良.参附注射液在小儿川崎病治疗中的应用价值研究[J].广州医药,2018,49(3):77-79.
[15]黄卫.参附注射液联合左西孟旦治疗急性心力衰竭的临床疗效及其对患者炎性细胞因子和血管内皮细胞功能的影响[J].实用心脑肺血管病杂志,2016,24(12):80-83.
[16]秦丹梅,李成银.参附注射液对晚期非霍奇金淋巴瘤化疗后阳虚证候的改善作用[J].中国中医急症,2013,22(6):985-986.
[17]雷波,徐艳梅,马爱兰.参附注射液联合酸磷肌酸钠治疗小儿病毒性心肌炎临床观察[J].中国实用医药,2015,10(21):159-160.
[2]向龙,陈聪.丙种球蛋白治疗不敏感川崎病的临床探讨[J].检验医学与临床,2016,3(6):826-828.
[3]张清友,简佩君,杜军保.风湿热、心内膜炎及川崎病委员会,美国心脏病学会及美国儿科学会川崎病的诊断、治疗及长期随访指南介绍[J].实用儿科临床杂志,2012,27(13):1 049-1 056.
[4]林瑞峰,李红,陈小夏,等.丙种球蛋白联合阿司匹林治疗川崎病34例临床疗效观察[J].数理医药学杂志,2015,28(6):872-872,873.
[5]朱迪,罗钢.不完全川崎病患儿的实验室检查分析[J].中国医科大学学报,2017,46(3):219-222.
[6]程立平.丙种球蛋白联合阿司匹林片治疗川崎病的疗效研究[J].中国临床药理学杂志,2017,33(15):1 425-1 427.
[7]胡春艳.丙种球蛋白治疗儿童不敏感川崎病的临床效果[J].中国急救医学,2016,36(Z1):224-225.
[8]隋晓东,田执梁.难治性川崎病治疗进展[J].儿科药学杂志,2018,24(3):58-62.
[9]Shulman ST.Early steroid therapy reduces Kawasaki disease coronary complications[J].J Pediatr,2017,182:401-404.
[10]Zhu BH,Lv HT,Sun L,et al.A meta-analysis on the effect of corticosteroid therapy in Kawasaki disease[J].Eur JPediatr,2012,171(3):571-578.
[11]任琳琳,王彩霞,李静,等.中药联合丙种球蛋白和阿司匹林治疗川崎病疗效观察[J].现代中西医结合杂志,2016,25(17):1 890-1 892.
[12]李开,鄢素琪.中医营气卫血辩证联合丙种球蛋白治疗儿童川崎病的临床研究[J].中华中医药学刊,2016,34(10):2 527-2 531.
[13]夏川江.参附注射液联合人免疫球蛋白治疗川崎病的临床研究[J].现代药物与临床,2016,31(6):834-837.
[14]闫启良.参附注射液在小儿川崎病治疗中的应用价值研究[J].广州医药,2018,49(3):77-79.
[15]黄卫.参附注射液联合左西孟旦治疗急性心力衰竭的临床疗效及其对患者炎性细胞因子和血管内皮细胞功能的影响[J].实用心脑肺血管病杂志,2016,24(12):80-83.
[16]秦丹梅,李成银.参附注射液对晚期非霍奇金淋巴瘤化疗后阳虚证候的改善作用[J].中国中医急症,2013,22(6):985-986.
[17]雷波,徐艳梅,马爱兰.参附注射液联合酸磷肌酸钠治疗小儿病毒性心肌炎临床观察[J].中国实用医药,2015,10(21):159-160.